Shrinking the damage
illustration by Alejandro Salas Strus
TORONTO (CUP) – BOISTEROUS TEENS CLING to their drinks and stumble across a carpeted floor stained by spilt beer and dirty shoes. Music blares from nearby speakers as Brooke Manning (names have been changed to protect anonymity) pushes her way through a crowd of drunken partygoers. Once outside, 15-year-old Manning shares a cigarette with a charming fellow named Brent, who later invites her to the local convenience store. Craving a Coke, Manning hops in Brent’s car, oblivious of what is to come.
Brent drives to an abandoned parking lot and turns off the engine. In a matter of seconds Manning is struggling to release herself from the tight hold Brent has on her. She kicks and screams and shakes, but Manning ultimately does not have the strength to ward off her attacker. After Brent is finished he orders Manning to get out of the car, and then vanishes. Drenched in tears, Manning realizes she will forever be a victim of sexual assault.
A “soul-shattering” future
For years, Manning did not tell anyone about what happened, although family members and friends noticed she was becoming distant and depressed. Her mother blamed the symptoms on hormones. Though Manning suffered in silence, she did not suffer alone.
“Experiencing something like that devours you. It shatters your soul for a long time,” said Manning, who decided to undergo therapy last summer. “I hated everyone. I took my anger out on family and friends so it became hard to have meaningful relationships.” Six years later, Manning, now a third-year student at Ryerson University, still has vivid flashbacks of the event. She avoids parties. She avoids parking lots. She avoids sex with her boyfriend. It is difficult for her to have close relationships because she no longer trusts people.
Manning suffers from post-traumatic stress disorder (PTSD), a severe anxiety condition that can be developed after being exposed to something traumatic. But she isn’t the only one suffering; PTSD has made a victim all those close to her as well.
Candice Monson, a leading expert on the effects of PTSD, joined Ryerson staff in July 2009. Determined to help patients with the interpersonal aspects of the disorder, Monson, along with a team of graduates from Ryerson’s clinical psychology program, conduct free couples treatment to anyone whose relationship has been affected by trauma-induced stress.
Monson helps couples build an understanding of the disorder and confront issues they have been avoiding. It is the only treatment of its kind offered in Canada.
According to the Canadian Mental Health Association, PTSD affects almost 10 per cent of the population. Younger people are more at risk for PTSD because they are in more motor vehicle accidents and are more vulnerable to substance abuse and sexual assault. And while men are usually exposed to more traumas in a lifetime, women are twice as likely to develop PTSD.
The most common traumas that can induce PTSD are combat and sexual assault. Symptoms of PTSD include vivid flashbacks and nightmares, irritability and anger, and—most commonly—avoidance. Victims will often avoid anything that reminds them of the event.
While working her way through graduate school, Monson began questioning why there wasn’t a greater emphasis on treating PTSD. Unlike depression and certain other mental illnesses, PTSD is a disorder with a known root cause.
“If you have a mental illness, this is not a bad one to have,” said Monson.
It is one of the most treatable mental disorders, she explained, yet many people do not seek help.
When Manning first sought clinical help, she was prescribed depression medications. The more pills she popped, the more numb she became to her memories. Though her paranoia eased, she still felt she was not confronting the problem.
“Taking the meds was like shoving dirt under the rug. Outwardly I didn’t seem affected, but the issue was still there,” said Manning.
“You have to ask yourself: do I want to do symptom management for the rest of my life, or do I want to go after what caused this problem so that I can have my life back?” said Monson, who is the director of clinical training in psychology at Ryerson.
After receiving her PhD from the University of Nebraska, Monson started researching and conducting individual therapy sessions for patients suffering from the illness. Recognizing a need for PTSD treatment that catered to the interpersonal effects of the disorder, Monson has dedicated the past 10 years of her research to developing a new form of couples treatment.
A burden shared
In 2000, she began piloting the PTSD couples therapy in Vermont. She treated former Vietnam War veterans and their wives with great success. Monson moved treatment to the University of Boston where she opened the therapy to all couples, a large percentage of whom were Iraq War veterans.
One of her patients, having been deployed to Iraq as a sergeant in the U.S. Marines, witnessed a child and adult being killed and mutilated by insurgents. This image stuck with him after he returned from combat. He felt disconnected from his wife. He became controlling, cold-hearted, and sexually inactive in his marriage. As a consequence, his wife grew depressed and frustrated, carrying the burden of her husband’s untreated PTSD, a common tension among couples affected by the disorder.
War veterans are one of the groups of people most susceptible to PTSD. Trapped by their memories, many are left to brood over flashbacks of gunfire, bombings and death. Since Canada first deployed troops to Afghanistan, the number of soldiers discovered to be suffering from PTSD has more than tripled.
Today, PTSD accounts for 63 per cent of cases of mental illnesses suffered by former soldiers, according to figures released by Veterans Affairs Canada.
In Monson’s program, all PTSD patients and their significant others undergo the same therapy, regardless of their trauma. Treatment consists of three stages. The first is the understanding phase, in which the therapist explains the process and provides couples with conflict-management skills. The second stage aims to help the couple develop better communication skills, since lack of expression is largely associated with PTSD. The third and final stage helps the couple develop a list of things they’ve been avoiding—such as going out in public, showing physical affection, or expressing emotions to each other—and reintegrate these activities into their relationship. Patients undergo 15 treatment sessions that are usually conducted within a three-month span.
No easy solution
Brad and Katelyn, a student couple living in Boston, saw a flyer posted in a local library advertising the treatment and jumped on the opportunity for free therapy. During her early college years, Katelyn was sexually assaulted, a trauma that influenced her ability to express herself sexually and communicate in romantic relationships.
Brad said the treatment enabled them to be more open with each other. In the past, he often felt unable to confidently express his feelings to Katelyn without worrying about her reaction.
“I’d be afraid to say things,” he said. “I’d be tip-toeing around a situation, which would upset her even more.”
Post-treatment, he feels more comfortable communicating his thoughts and concerns with her. Though Katelyn admitted she is still bothered by the memories, she no longer blames herself for what happened or avoids discussing her issues with Brad.
“Unfortunately I don’t have a memory eraser, or else I’d be a rich woman,” said Monson. “What we’re aiming for is that while you have the memory, it doesn’t have the same power over you.”
Many of Monson’s patients blame themselves for the trauma they have experienced, a notion that treatment helps patients break away from.
“We as Westerners like to think we’re more powerful than our circumstance, and that we have control over them. But sometimes there are situations so determined that it doesn’t matter what we do,” said Monson.
In her experiences with couples treatment, Monson has seen many patients evolve from shattered beings to strong-willed, expressive individuals. Instead of suppressing their problems, treatment forces patients to confront them in a comfortable environment.
“Talk therapy should be the front-line treatment of this disorder,” said Monson, who believes that psychotherapy is twice as effective as medicine in the treatment of PTSD. “We need to push the envelope in terms of trying to help people who are not otherwise going to get help.”
Local resources
Think you may need treatment for PTSD or other mental-health issues? Check out these local services.
University of Ottawa Mental Health Services 100–100 Marie Curie Pr. 613-564-3950 ext. 225
Ottawa Anxiety and Trauma Clinic Billings Bridge Plaza 613-737-1194 ottanx@igs.net
